Bottom Line:
The mean time required for the entire procedure was approximately 20 minutes.All 4 FBs were successfully removed from the soft tissue under US guidance.Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.

Objective: We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases.

Materials and methods: Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydrodissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed.

Results: The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance.

Conclusion: Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.

Mentions:
A musculoskeletal radiologist performed all diagnostic US and US-guided removal of the FBs using a Logiq E9 (GE Medical Systems, Milwaukee, WI, USA) imaging device equipped with linear 6-15 MHz probes. The diagnosis was confirmed by US by identifying FBs ranging from 10 mm to 40 mm. US-guided removal of the FBs in the radiology department was initiated with US evaluation for the exact location and shape of the FB. Adjacent major vascular structures and tendons were also evaluated. After disinfecting the overlying skin, local anesthetics (lidocaine chlorhydrate 2%, Huons, Jecheon, Korea) were injected around the targeted skin area. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. The incision was made large enough for mosquito forceps (Halsted-Mosquito Forceps, Solco Medical, Seoul, Korea, 12 cm) to be inserted and wide enough to accommodate the passage of the FB. We adopted a hydro-dissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution (Figs. 1,2,3, Videos 1, 2 in the online-only Data Supplement). Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. If the FBs were located in a deeper portion of the soft tissue, such as the intramuscular layer, an 18-gauge spinal needle was introduced, through which a guide wire (0.03 inch, Terumo, Tokyo, Japan) was inserted. After removal of the spinal needle, we created a tract for introducing mosquito forceps with serial dilators (7-12 Fr, Cook, Bloomington, IN, USA) along the guide wire. When the tip of the mosquito forceps reached the FB, the wooden FBs were removed. All procedures were performed under real-time US guidance. The mean time required for the entire procedure was approximately 20 minutes. Prophylactic oral antibiotics (penicillin and amoxicillin) were administered to all patients for 5 days to prevent infectious complications after the procedure. There were no significant complications during the US-guided removal or long-term complications after the procedure.

Mentions:
A musculoskeletal radiologist performed all diagnostic US and US-guided removal of the FBs using a Logiq E9 (GE Medical Systems, Milwaukee, WI, USA) imaging device equipped with linear 6-15 MHz probes. The diagnosis was confirmed by US by identifying FBs ranging from 10 mm to 40 mm. US-guided removal of the FBs in the radiology department was initiated with US evaluation for the exact location and shape of the FB. Adjacent major vascular structures and tendons were also evaluated. After disinfecting the overlying skin, local anesthetics (lidocaine chlorhydrate 2%, Huons, Jecheon, Korea) were injected around the targeted skin area. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. The incision was made large enough for mosquito forceps (Halsted-Mosquito Forceps, Solco Medical, Seoul, Korea, 12 cm) to be inserted and wide enough to accommodate the passage of the FB. We adopted a hydro-dissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution (Figs. 1,2,3, Videos 1, 2 in the online-only Data Supplement). Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. If the FBs were located in a deeper portion of the soft tissue, such as the intramuscular layer, an 18-gauge spinal needle was introduced, through which a guide wire (0.03 inch, Terumo, Tokyo, Japan) was inserted. After removal of the spinal needle, we created a tract for introducing mosquito forceps with serial dilators (7-12 Fr, Cook, Bloomington, IN, USA) along the guide wire. When the tip of the mosquito forceps reached the FB, the wooden FBs were removed. All procedures were performed under real-time US guidance. The mean time required for the entire procedure was approximately 20 minutes. Prophylactic oral antibiotics (penicillin and amoxicillin) were administered to all patients for 5 days to prevent infectious complications after the procedure. There were no significant complications during the US-guided removal or long-term complications after the procedure.

Bottom Line:
The mean time required for the entire procedure was approximately 20 minutes.All 4 FBs were successfully removed from the soft tissue under US guidance.Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.

Objective: We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases.

Materials and methods: Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydrodissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed.

Results: The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance.

Conclusion: Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.